646 SELVA LAKES CIR - PLUMBING rVi'Jr
r- Jr;
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J T ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1060
Job Type: PLUMBING ONLY
Description: PLUMBING - 2 FIXTURES
Estimated Value: $700.00
Issue Date: 5/19/2016
Expiration Date: 11/15/2016
PROPERTY ADDRESS:
Address: 646 SELVA LAKES CIR
RE Number: 172027-5802
PROPERTY OWNER:
Name: BRAZA, PETER A
Address: 646 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: ATLANTIC COAST PLUMBING CORP.
Address: 3653 REGENT BLVD APT 305 QA NICHOLAS ARLON
PARRISH
Phone: 904-997-3278
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
0
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
05/06/2016 11:25 FAX 9046459363 atlantic-coast 001
05-06-18; 10: 14 ;From: 1 :96459363 ;9042475845 # 11 1
PLUMBING PERMIT APPLICATION
CI'T'Y' OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904)247-5845 i (o—`DL
JOB ADDRESS:_____ J V a �a k-e S ; PLRMTr#
—
NEW OR REPLACEMENT INSTALLATION: Project Value$ "7 0 p, O o
TYPE OFFUCIv1LE QrY nTE OF FIXTURE
Bathtub QTS'
Clothes Washer Septic Tank&Pit
.Dishwasher Shower
Drinking Fountain '� Shower Pan
Floor Drain
Slop Sink
Floor Sink
Three Comparttnent Sink
Tose]gibs Toilet
Hese
Sink –� Urinal
Laundry Tray —. Vacuum Breakers
J,avatory Water Connected Appliances
Other Fixtures Water Heater
---_. Water Treating Systm
R. -PEPE:
TYn OP PDCTIIRE QTY TYPFOFFIXTURJ:
Bathtub Qom'
Clothes Washer Septic Tank&Pit
DishwasherShower —
Drinking Fountain – .__ Shove Pan
Floor DrainSlop Sink `�"—
Plaor Sink Three Compartment Sink
HoseooAibg Toilet
Kitchen Sink Urinal
Vacuum
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Y txtures Water Treating System
fxSCELLANEOUS:
Sewer Replacement 0 Back Flow Preventer o Grease intetceptor(Trap) gallons(Requires 3 sets of pluns)
Lawn Sprinkler System-Numbor of Beads 0 Well
4.0
`SJRWD Well Completion Form. Completed form to be submitted to th diDepartment for finalinspection."
Other �
lama.. - Ammilir
mit becomes void if work dons not commence within n nix month path). or work is suspended or abandoned for six months.X hereby certify that I hew read
3 application and know the 8ftrnc t0 be true and cameo. All provisions of laws and ordinances governing this work will bo complied with whether specified
mot. The permit does not give authority to violate the provisions of any other state or loom taw regulation construction or the performance of eonatruetien,
verty Owners 2\12inac •' 1 - ," Ct Asir/S Phoria Number. 2Z.-A10:2____
unbing Company t_ Ail-h(°,p a,mac.+ e l U,}')t 19�
I no' Office Phone_09-1-3 3.
A,afiress: 3 t>7� �. 7 ���w s�9��
.4 . S ct i -C 3D5 City...C.0 tin vi!Li State R.-Zip32211-1...:ensc T4olde;r
(Print): I en • QS P�s :ate.t`r. •,to Corti. ation/Reglstl. tion# ( ! 5 0 ID
farized Signature of L'icense Holder 1
-
Before me this L� day of M a, 20_ I (p
LINDSAY BELMONT Signature of Notary Public r e
MY COMMISSION#FF949802 0'.
(1/,/, EXPIRES:JAN 12,2020
Bonded throuptl 1st state Insurance